ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 19 (4)
Volume: 19  Issue: 4 - 2016
EDITORIAL
1. Editorial
Burhanettin Kaya
Page 155
Abstract |Turkish PDF

RESEARCH ARTICLE
2. Evaluation of neurocognitive deficits in obsessive compulsive disorder with Adas-cog: A comparative study with the healthy control group
Ayşe Döndü, Çağdaş Öykü Memiş, Levent Sevinçok
doi: 10.5505/kpd.2016.10820  Pages 156 - 166
OBJECTİVES: Obsessive compulsive disorder (OCD) is characterized by recurrent intrusive thoughts and repetitive behaviors or mental acts compulsions. Previous studies obviously indicate that OCD patients have several impairments in memory and other neurocognitive functions. Our primary aim is to assess the cognitive impairment in OCD patients through Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) which is widely used in Alzheimer’s Dementia. METHODS: Thirty two patients with a diagnosis of OCD and twenty six healthy controls were administrated Structured Clinical Interview for DSM Disorders (SCID-I), Yale Brown Obsessive Compulsive Scale (Y-BOKS), ADAS-Cog Scale, Mini Mental Status Examination (MMSE), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scales (HARS). RESULTS: When we compared two groups, OCD subjects performed significantly worse in the fields of ADAS-Cog Total (p<0.0001), Word Recall (p<0.0001), Word Recognition (p<0.0001) Commands (p<0.0001), Constructional Praxis (p<0.05) and Orientation (p<0.05) Tests of ADAS-Cog compared to the healthy control group. CONCLUSION: We suggest that ADAS-Cog might be used as an available tool to assess some neurocognitive deficits in OCD patients. Further studies in larger samples of OCD patients are needed to assess the availability of ADAS-Cog in measuring the neurocognitive impairments.

3. Marital adjustment and family functioning in bipolar disorder type I in comparison with rheumatoid arthritis
Öznur Taşdelen, Rugül Köse Çınar, Yasin Taşdelen, Yasemin Görgülü, Ercan Abay
doi: 10.5505/kpd.2016.48568  Pages 167 - 175
INTRODUCTION: Marriage is known to affect health and functioning. Beside the importance of the marital status, levels of marital adjustment and family functioning are found to have greater impact on health. Chronic diseases could have negative effects on marital adjustment and family functioning. Our aim in this study was to compare marital adjustment and family functioning between bipolar disorder (BD) type I, RA patients and their spouses.
METHODS: Study sample included 49 BD type I, 48 RA patients and their spouses. BD patients were evaluated by the Structured Clinical Interview for DSM-IV Axis I Disorders, the Hamilton Rating Scale for Depression, and the Young Mania Rating Scale. BD patients in remission state and RA patients in chronic state were included, patients in acute state were excluded. The patients with RA and their spouses and the spouses of the BD patients were evaluated fort he detection of comorbid psychiatric disorders and the individuals who had any psychiatric disorder were excluded from the study. Marital adjustment and family functioning were assessed by using the “Berksun-Söylemez-Kavacık Marital Adjustment and Family Functioning Scale”.
RESULTS: BD-I patients had higher total marital adjustment and family functioning scores compared to the RA patients (p = 0.004). Spouses of BD-I patients had also higher scores than the spouses of RA patients (p = 0.001). When the scale is compared between the spouses, RA patients and their partners had similar scores. BD-I patients’ partners had worse scores than the BD-I patients.
DISCUSSION AND CONCLUSION: BD-I even in remission state disrupts marital adjustment and family functioning more than a disease presenting with chronic pain. This result must be considered in treatment of the BD patients. It should be kept in mind that the spouses of BD patients are more dissatisfied with their marriages than the BD patients. Adjustment of the spouse to the marriage is important.

4. Variables affecting burnout levels among medical doctors working in internal and surgical branches and the relationship of burnout with work engagement and organizational commitment
Reyhan Algül, Doğan Yılmaz, Ürün Özer, Burhanettin Kaya
doi: 10.5505/kpd.2016.92485  Pages 176 - 184
INTRODUCTION: Burnout is described as physicial, mental and emotional exhaustion caused by work stress, development of negative emotions towards his/her job, colleages, even him/herself. Serious outcomes of burnout in terms of workers, clients and organizations are emphasized in the literature. It may cause resignation, absenteeism, demotivation, decrease in performance as well as more serious consequences such as fatigue, psychosomatic disorders, depression, anxiety, sleep disturbance, problems with partner/family, alcohol or substance abuse. Burnout is especially reported in individuals who do “people-work” and medicine is considered one of the professions carrying the highest risk of burnout. In this study, we aimed to investigate variables affecting burnout levels among medical doctors working in internal and surgical branches and examine the relationship of burnout with work engagement and organizational commitment.
METHODS: 82 medical doctors working in a private university hospital were included in the study which was designed as cross-sectional. Sociodemographic and professional data forms, Maslach Burnout Inventory, Organizational Commitment Scale and Work Engagement Scale were completed.
RESULTS: Three participants who did not fully complete study forms were exluded and the data of 79 were evaluated. Among participants, 40(50.6%) were working in internal and 39(49.4%) in surgical branches. There was no difference between branches in sociodemographic features and scale scores. Gender and having children were sociodemographic features; income and duration of occupation were professional features affecting scale scores. Positive and negative relationships between three scales and their subscales were detected in correlation analyses.
DISCUSSION AND CONCLUSION: Our findings suggest that there is no difference between medical doctors working in internal and surgical branches in burnout; but gender, having children, income and duration of occupation may affect burnout level. Organizational commitment and work engagement are among variables affecting burnout level, therefore efforts which will be spent for amelioration of these elements may provide benefit in the reduction of medical doctors' burnout.

5. Comorbidity in children and adolescents with conduct disorder: A retrospective analysis of 6-month period of time
Zeynep Göker, Çağatay Uğur, Gülser Dinç, Özlem Hekim Bozkurt, Özden Şükran Üneri
doi: 10.5505/kpd.2016.57966  Pages 185 - 193
INTRODUCTION: This study aimed to evaluate the clinical features of children and adolescents with conduct disorder diagnosed over a 6-month period of time.
METHODS: Between January and June 2015, data of 71 cases with conduct disorders were analyzed retrospectively. Symptoms related to the disorder began before 10 years of age were accepted as “early onset”. Total IQ, psychiatric disorders and treatment were recorded. SPSS was used for analyses.
RESULTS: Male sex was 66.2% of all cases and mean age was 12.5 years of age. 50.7% of all were counted as ‘conduct disorder (CD)’ and the rest of as ‘conduct disorder-not otherwise specified (NOS)’. Mean age was higher in CD group than that of CD-NOS (p=0.002). 32.4% of all cases had ‘early-onset’ of the disorder. Being ‘early-onset’ in CD-NOS group was found as significant compared with the CD group (p=0.018). IQ levels of 80.3% of the cases was 80 and above and having under 80 IQ levels were found at significant rate in male sex (p=0.025).
9.9% of the cases had any substance use. Being male (p=0.682), having CD (p=1.000) or early onset of the disorder (p=0.415) were not found as related to the substance use. 64.8% of the cases had another psychiatric disorder with most frequently of attention deficit hyperactivity disorder (21.1%). Psychiatric comorbidity was higher in CD group than that of CD-NOS (p value under 0.001).
59.2% of the cases had pharmacotherapy, 16.9% of had psychotherapy and 12.7% of them had coombined therapy.
Pharmacotherapy was higher in CD group than that of CD-NOS (p=0.035).
Mostly recommended agents were atypical antipsychotics (risperidone, aripipirazole, 49.3%). Antipsychotics were higher in males (p=0.005) whereas antidepressants were higher in females (p=0.023).
DISCUSSION AND CONCLUSION: CD-NOD emerges before 10 years of age. Psychiatric comorbidity is higher in CD. Pharmacotherapy applied to the CD group explains with the presence of comorbidity.

6. Psychiatric Disorders in Medically Ill Inpatients Referred for Consultation in a University Hospital
Evnur Kahyacı Kılıç, Rugül Köse Çınar, Mehmet Bülent Sönmez, Yasemin Görgülü
doi: 10.5505/kpd.2016.07108  Pages 194 - 201
INTRODUCTION: The distribution of psychiatric consultations in a university hospital according to the socio-demographical attributes of the patients, the clinics from which the consultations were asked, the psychiatric diseases that were diagnosed and the psychiatric treatments were analyzed in this trial.
METHODS: The consultation forms of the patients aged 18 or more that were being treated in hospital from 1st Janurary to 31th December, 2011 and consulted to the psychiatry clinic were analyzed retrospectively. The diagnoses were made according to DSM- IV-TR diagnostic criteria. The statistical analysis were done with SPSS 20.0 and the results were given as percentage values.
RESULTS: 422 female (54.5%), 353 male (45.5%) totally 755 patients who were under treatment in hospital except psychiatry clinic and conculted to psychiatry were included in this trial. The mean age of the patients were 50.4±15.5. The most common consulting clinics were internal medicine (%35.2), pysical therapy and rehabilitation (%15.2) and general surgery (%9.7). The consulting reasons were depressive complaints (%24.5), psychiatric assesment asking without any reason (%24.3), agitation (%13.4) and as a result of prior psychiatric illness history (%10.1). Pyschiatric illnesses that were diagnosed were adjustment disorder (%19), delirium (%18.1) and depression (%17.4). There were no psychological disease that were providing diagnostic criteria in 23.7% of the patients. 35.2% of the patients were advised treatment with antidepressants, 22.6% with antipsychotics, 9% with benzodiazepines, 1.2% with mood stabilizers but 32 % were not advised any medical treatment.
DISCUSSION AND CONCLUSION: The results of our investigation emphasizes the importance of consultation liaison psychiatry unit. By collaboration with other clinics, global assesment but not only physical wellness also psychological assesment of the patients will be evaluated.

REVIEW
7. A Review about the Mediating Role of Early Maladaptive Schemas in the Relationship between Childhood Emotional Abuse and Depression
Reyhan Arslan
doi: 10.5505/kpd.2016.42714  Pages 202 - 210
Child abuse that may be defined as acts affecting child’s development adversely has been there for centuries; however, it has gained importance medically and socially in the last century. In recent years, the interest and awareness in child abuse have been increased in Turkey, as well. The different effects of childhood physical and sexual abuse have been excessively examined in the past studies; however, emotional abuse has been attracted much attention as a distinct topic in recent years. Childhood emotional abuse is defined as the acts of adults that impair the child’s personality and psychosocial development and it is more complicated, least recognized, but also the most common type of abuse when compared to other subtypes of abuse. There are many adverse effects of emotional abuse that appears in both childhood and adulthood. As indicated in research studies, depression is one the most commonly encountered psychological disorders in people who had emotionally abused in childhood. However, not everyone who experiences emotional abuse will develop the disorder, so examining the role of the mediating factors in the relationship between childhood emotional abuse and depression is important for understanding the issue more clearly. One of the most significant factors that can mediate this relationship is early maladaptive schemas. Thus, in this review, the mediating role of early maladaptive schemas in the relationship between childhood emotional abuse and depression in adulthood will be examined.

CASE REPORT
8. Amotivational Syndrome Caused by Cannabis Use: A Case Who Improved with Additional Testosterone Combination Treatment
Suat Ekinci, Hanife Uğur Kural
doi: 10.5505/kpd.2016.88597  Pages 211 - 214
Cannabis which is obtained from seeds and dried leaves of the cannabis sativa plant is widely used in the world due to its recreational effect. Epidemiological studies were suggested huge differences among countries in terms of using cannabis at least once. The percentiles of use for countries were determined as 41% in England, 17% in Denmark, 6% in Hungary, and 1.2-4% in Turkey. Lots of studies about cannabis use disorders, clinical classification, and treatment were conducted. However, amotivational syndrome caused by cannabis use is not only a clinically less known phenomenon but also we have limited clinical experience about this syndrome. Amotivational syndrome is a syndrome which is caused by cannabis use and which goes along with the cognitive and emotional dysfunctions such as decrease in energy and motivation, lack of social interaction, apathy, decrease in goal-oriented activities, poor judgement, lack of concentration, and memory problems. In studies, it was shown that clinical symptoms of motivational syndrome such as decrease in motivation and energy in 16-21% of people with cannabis use disorder was observed but motivational syndrome emerges as a clinical phenomenon which has been diagnosed less and we have a few studies about definitive diagnosis and treatment. For treatment, it is recommended that underlying problem should be eliminated and that cannabis use should be stopped.. In this article, a case which had amotivational syndrome caused by cannabis use and which had a recovery in clinical symptoms with the treatment of adding testosterone.

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